Senate File 649 - Introduced SENATE FILE 649 BY COMMITTEE ON APPROPRIATIONS (SUCCESSOR TO SSB 1237) A BILL FOR An Act relating to and making appropriations to the department 1 of veterans affairs and the department of health and human 2 services, and related provisions and appropriations, 3 including aging and disability services; behavioral health, 4 public health, community access and eligibility; the medical 5 assistance program, state supplementary assistance, Hawki, 6 and other health-related programs; family well-being and 7 protection; state-operated specialty care; administration 8 and compliance; transfers, cash flows, and nonreversions; 9 prior appropriations; the beer and liquor control fund, 10 and the behavioral health fund; report on nonreversion of 11 moneys; emergency rules; more options for maternal support 12 program; and a hospital directed payment program; and 13 including effective date and retroactive applicability 14 provisions. 15 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 16 TLSB 1004SV (1) 91 lh/ko

S.F. 649 DIVISION I 1 DEPARTMENT OF VETERANS AFFAIRS —— FY 2025-2026 2 Section 1. DEPARTMENT OF VETERANS AFFAIRS. There is 3 appropriated from the general fund of the state to the 4 department of veterans affairs for the fiscal year beginning 5 July 1, 2025, and ending June 30, 2026, the following amounts, 6 or so much thereof as is necessary, to be used for the purposes 7 designated: 8 1. DEPARTMENT OF VETERANS AFFAIRS ADMINISTRATION 9 For salaries, support, maintenance, and miscellaneous 10 purposes, for not more than the following full-time equivalent 11 positions: 12 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,369,205 13 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FTEs 15.00 14 2. IOWA VETERANS HOME 15 For salaries, support, maintenance, and miscellaneous 16 purposes: 17 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 8,145,736 18 a. The Iowa veterans home billings involving the department 19 of health and human services shall be submitted to the 20 department on at least a monthly basis. 21 b. The Iowa veterans home expenditure report shall be 22 submitted monthly to the general assembly. 23 3. HOME OWNERSHIP ASSISTANCE PROGRAM 24 For transfer to the Iowa finance authority for the 25 continuation of the home ownership assistance program for 26 persons who are or were eligible members of the armed forces 27 of the United States or eligible service members pursuant to 28 section 16.54: 29 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 2,700,000 30 DIVISION II 31 AGING AND DISABILITY SERVICES —— FY 2025-2026 32 Sec. 2. DEPARTMENT OF HEALTH AND HUMAN SERVICES —— AGING 33 AND DISABILITY SERVICES. There is appropriated from the 34 general fund of the state to the department of health and human 35 -1- LSB 1004SV (1) 91 lh/ko 1/ 32

S.F. 649 services for the fiscal year beginning July 1, 2025, and ending 1 June 30, 2026, the following amount, or so much thereof as is 2 necessary, to be used for the purposes designated: 3 For aging programs for the department of health and human 4 services and area agencies on aging to provide citizens of 5 Iowa who are 60 years of age and older with case management; 6 for Iowa’s aging and disabilities resource centers; for the 7 return to community program; for the purposes of chapter 231E; 8 to administer the prevention of elder abuse, neglect, and 9 exploitation program pursuant to section 231.56A, in accordance 10 with the requirements of the federal Older Americans Act of 11 1965, 42 U.S.C. §3001 et seq., as amended; for the operation of 12 the dependent adult abuse services program pursuant to chapter 13 235B; and for other services which may include but are not 14 limited to adult day care, respite care, chore, information 15 and assistance, and material aid, for information and options 16 counseling for persons with disabilities, and for salaries, 17 support, administration, maintenance, and miscellaneous 18 purposes: 19 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 19,208,180 20 1. Moneys appropriated in this section may be used to 21 supplement federal moneys received under federal regulations. 22 To receive moneys appropriated in this section, a local area 23 agency on aging shall match the moneys with moneys from other 24 sources according to rules adopted by the department. Moneys 25 appropriated in this section may be used for services not 26 specifically enumerated in this section only if approved by the 27 department as part of an area agency on aging’s area plan. 28 2. Of the moneys appropriated in this section, $949,282 29 shall be used for the family support center component of the 30 comprehensive family support program under section 225C.47. 31 3. Of the moneys appropriated in this section, $33,632 shall 32 be used to build community capacity through the coordination 33 and provision of training opportunities in accordance with the 34 consent decree of Conner v. Branstad, No. 4-86-CV-30871 (S.D. 35 -2- LSB 1004SV (1) 91 lh/ko 2/ 32

S.F. 649 Iowa, July 15, 1994). 1 DIVISION III 2 BEHAVIORAL HEALTH —— FY 2025-2026 3 Sec. 3. DEPARTMENT OF HEALTH AND HUMAN SERVICES —— 4 BEHAVIORAL HEALTH. There is appropriated from the general fund 5 of the state to the department of health and human services for 6 the fiscal year beginning July 1, 2025, and ending June 30, 7 2026, the following amount, or so much thereof as is necessary, 8 to be used for the purposes designated: 9 For behavioral health prevention, treatment, and recovery 10 efforts to reduce the prevalence of the use of, provide 11 treatment for, and support recovery from alcohol, tobacco, and 12 substance use and misuse, problem gambling, and other addictive 13 behaviors. Activities shall align with accepted best practice 14 guidance standards for behavioral health including those 15 published by the centers for disease control and prevention of 16 the United States department of health and human services, and 17 the substance abuse and mental health services administration 18 of the United States department of health and human services, 19 for health promotion; universal, selective, and indicated 20 prevention; treatment; and recovery services and supports; and 21 shall include a 24-hour helpline, public information resources, 22 professional training, youth prevention, program evaluation, 23 and efforts at the state and local levels: 24 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 24,442,121 25 1. Of the moneys appropriated in this section, $300,000 26 shall be used to support the work of the children’s behavioral 27 health system including evidence-based behavioral health 28 prevention, treatment, and recovery services and supports for 29 children and their families pursuant to the intent specified in 30 section 225C.6B, subsection 1. 31 2. Of the moneys appropriated in this section, $950,000 32 shall be used for an integrated substance use disorder managed 33 care system. The department shall maintain the level of mental 34 health and substance use disorder treatment services provided 35 -3- LSB 1004SV (1) 91 lh/ko 3/ 32

S.F. 649 by the managed care contractors, and shall take the steps 1 necessary to continue the federal waivers as needed to maintain 2 the level of services. 3 Sec. 4. DEPARTMENT OF HEALTH AND HUMAN SERVICES —— SPORTS 4 WAGERING RECEIPTS FUND. There is appropriated from the 5 sports wagering receipts fund created in section 8.57I, to the 6 department of health and human services for the fiscal year 7 beginning July 1, 2025, and ending June 30, 2026, the following 8 amount, or so much thereof as is necessary, to be used for 9 behavioral health prevention, treatment, and recovery efforts 10 to reduce the prevalence of the use of, provide treatment for, 11 and support recovery from alcohol, tobacco, and substance use 12 and misuse, problem gambling, and other addictive behaviors: 13 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,750,000 14 DIVISION IV 15 PUBLIC HEALTH —— FY 2025-2026 16 Sec. 5. DEPARTMENT OF HEALTH AND HUMAN SERVICES —— PUBLIC 17 HEALTH. There is appropriated from the general fund of the 18 state to the department of health and human services for the 19 fiscal year beginning July 1, 2025, and ending June 30, 2026, 20 the following amount, or so much thereof as is necessary, to be 21 used for the purposes designated: 22 For programs that support health promotion, protect the 23 health and safety of the public, conduct disease surveillance 24 and investigation to reduce the incidence of morbidity and 25 mortality, serve individuals with chronic conditions including 26 but not limited to cancer, support the Iowa donor registry as 27 specified in section 142C.18, and strengthen the health care 28 delivery system and workforce to improve health outcomes for 29 all Iowans: 30 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 22,413,369 31 1. Of the moneys appropriated in this section, the following 32 amounts are allocated to the department of health and human 33 services to be used as follows to support the goals of 34 increased access, health system integration, and engagement: 35 -4- LSB 1004SV (1) 91 lh/ko 4/ 32

S.F. 649 a. $600,000 for distribution to a nonprofit organization 1 that established the first statewide drug donation repository 2 for continuation of the pharmaceutical infrastructure for 3 safety net providers established as described in 2007 Iowa 4 Acts, chapter 218, section 108, and for the prescription drug 5 donation repository program established in chapter 135M. 6 Moneys under this paragraph shall be distributed in their 7 entirety on July 1, 2025, for the purpose specified. 8 b. $374,000 for distribution to free clinics, as defined in 9 section 135.24, and a nonprofit organization that facilitates 10 the initiation, operation, and collaboration of free clinics 11 for necessary infrastructure, statewide coordination, provider 12 recruitment, service delivery, and provision of assistance to 13 patients in securing a medical home inclusive of oral health 14 care. Of the moneys allocated, $40,000 shall be used to lower 15 fees associated with using an electronic prescribing system. 16 Moneys under this paragraph shall be distributed in their 17 entirety on July 1, 2025, for the purpose specified. 18 c. $25,000 for distribution to an organization that raises 19 awareness about issues related to rural health clinics, and 20 necessary infrastructure and service delivery transformation. 21 Moneys under this paragraph shall be distributed in their 22 entirety on July 1, 2025, for the purpose specified. 23 d. $225,000 for distribution to an organization that is 24 the oldest continuously operating medical society in the state 25 for continuation of safety net provider patients access to 26 specialty care as described in 2007 Iowa Acts, chapter 218, 27 section 109. Moneys under this paragraph shall be distributed 28 in their entirety on July 1, 2025, for the purpose specified. 29 2. Of the moneys appropriated in this section, $600,000 30 shall be used for rural psychiatric residencies for residents 31 selected on or before June 30, 2025. 32 3. The university of Iowa hospitals and clinics under 33 the control of the state board of regents shall not receive 34 indirect costs from the moneys appropriated in this section. 35 -5- LSB 1004SV (1) 91 lh/ko 5/ 32

S.F. 649 The university of Iowa hospitals and clinics billings to the 1 department shall be, at a minimum, on a quarterly basis. 2 DIVISION V 3 COMMUNITY ACCESS AND ELIGIBILITY —— FY 2025-2026 4 Sec. 6. DEPARTMENT OF HEALTH AND HUMAN SERVICES —— COMMUNITY 5 ACCESS AND ELIGIBILITY. There is appropriated from the 6 general fund of the state to the department of health and human 7 services for the fiscal year beginning July 1, 2025, and ending 8 June 30, 2026, the following amount, or so much thereof as is 9 necessary, to be used for the purposes designated: 10 To be used for salaries, support, maintenance, and 11 miscellaneous purposes and for family investment program (FIP) 12 assistance in accordance with chapter 239B, and for other costs 13 associated with providing needs-based benefits or assistance 14 including but not limited to maternal and child health, oral 15 health, obesity prevention, the promotion of independence 16 and self-sufficiency through employment, job opportunities 17 and the basic skills (PROMISE JOBS) program, supplemental 18 nutrition assistance program (SNAP) employment and training, 19 the FIP diversion program, family planning, rent reimbursement, 20 and eligibility determinations for medical assistance, food 21 assistance, and the children’s health insurance program: 22 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 68,542,456 23 1. Of the child support collections assigned under FIP, 24 the federal share of the child support collections shall be 25 credited to the child support services appropriation made in 26 this division of this Act. Of the remainder of the child 27 support collections assigned under FIP, a portion shall be 28 credited to community access and eligibility, and the remaining 29 moneys may be used to increase recoveries, to sustain cash flow 30 in the collection services center refund account as provided in 31 section 252B.13A, or for technology needs. If child support 32 collections assigned under FIP are greater than estimated or 33 are otherwise determined not to be required for maintenance of 34 efforts, the state share of either amount is appropriated to 35 -6- LSB 1004SV (1) 91 lh/ko 6/ 32

S.F. 649 the department for child support services as described in this 1 Act, or may be transferred to or retained in the collection 2 services center refund account. 3 2. Of the moneys appropriated in this section, $3,075,000 4 shall be used for continuation of the department’s initiative 5 to provide for adequate developmental surveillance and 6 screening during a child’s first five years. The moneys shall 7 be used first to fully fund the current participating counties 8 to ensure that those counties are fully operational, with 9 the remaining moneys to be used for expanding participation 10 to additional counties. Full implementation and expansion 11 shall include enhancing the scope of the initiative through 12 collaboration with child health specialty clinics to promote 13 the use of developmental surveillance and screening to 14 support healthy child development through early identification 15 and response to both biomedical and social determinants of 16 healthy development by providing practitioner consultation 17 and continuous improvement through training and education, 18 particularly for children with behavioral conditions and 19 needs. The department shall also collaborate with the Medicaid 20 program and child health specialty clinics to assist in 21 coordinating the activities of the first five initiative into 22 the establishment of patient-centered medical homes developed 23 to improve health quality and population health while reducing 24 health care costs. To the maximum extent possible, moneys 25 allocated in this subsection shall be utilized as matching 26 moneys for Medicaid program reimbursement. 27 3. Of the moneys appropriated in this section, $1,145,102 28 is allocated to the Iowa commission on volunteer service for 29 programs and grants. 30 4. The university of Iowa hospitals and clinics under 31 the control of the state board of regents shall not receive 32 indirect costs from the moneys appropriated in this section. 33 The university of Iowa hospitals and clinics billings to the 34 department shall be, at a minimum, on a quarterly basis. 35 -7- LSB 1004SV (1) 91 lh/ko 7/ 32

S.F. 649 CHILD SUPPORT SERVICES 1 Sec. 7. CHILD SUPPORT SERVICES. There is appropriated from 2 the general fund of the state to the department of health and 3 human services for the fiscal year beginning July 1, 2025, and 4 ending June 30, 2026, the following amount, or so much thereof 5 as is necessary, to be used for the purposes designated: 6 For child support services, including salaries, support, 7 maintenance, and miscellaneous purposes: 8 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 15,644,114 9 1. Federal access and visitation grant moneys shall be used 10 for services designed to increase compliance with the child 11 access provisions of court orders, including but not limited to 12 neutral visitation sites and mediation services. 13 2. The appropriation made to the department for child 14 support services may be used throughout the fiscal year in the 15 manner necessary for purposes of cash flow management, and for 16 cash flow management purposes the department may temporarily 17 draw more than the amount appropriated provided the amount 18 appropriated is not exceeded at the close of the fiscal year. 19 DIVISION VI 20 MEDICAL ASSISTANCE PROGRAM —— STATE SUPPLEMENTARY ASSISTANCE —— 21 HEALTHY AND WELL KIDS IN IOWA PROGRAM AND OTHER HEALTH-RELATED 22 PROGRAMS —— FY 2025-2026 23 Sec. 8. MEDICAL ASSISTANCE PROGRAM, STATE SUPPLEMENTARY 24 ASSISTANCE, AND HEALTHY AND WELL KIDS IN IOWA PROGRAM. There 25 is appropriated from the general fund of the state to the 26 department of health and human services for the fiscal year 27 beginning July 1, 2025, and ending June 30, 2026, the following 28 amount, or so much thereof as is necessary, to be used for the 29 purposes designated: 30 For medical assistance program reimbursement and associated 31 costs as specifically provided in the reimbursement 32 methodologies in effect on June 30, 2025, except as otherwise 33 expressly authorized by law, consistent with federal law and 34 regulations, and contingent upon receipt of approval from the 35 -8- LSB 1004SV (1) 91 lh/ko 8/ 32

S.F. 649 office of the governor of reimbursement for each abortion 1 performed under the medical assistance program; for the state 2 supplementary assistance program; for the health insurance 3 premium payment program; and for maintenance of the healthy and 4 well kids in Iowa (Hawki) program pursuant to chapter 514I, 5 including supplemental dental services, for receipt of federal 6 financial participation under Tit. XXI of the federal Social 7 Security Act, which creates the children’s health insurance 8 program; and for other specified health-related programs: 9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,900,804,677 10 1. Of the moneys appropriated in this section, 11 $1,808,383,124 is allocated for medical assistance program 12 reimbursement and associated costs. 13 a. Of the moneys allocated in this subsection, $800,000 14 shall be used for the renovation and construction of certain 15 nursing facilities, consistent with chapter 249K. 16 b. Of the moneys allocated in this subsection, $3,383,880 17 shall be used for program administration, outreach, and 18 enrollment activities of the state family planning services 19 program pursuant to section 217.41B, and of this amount, the 20 department may use $200,000 for administrative expenses. 21 c. Of the moneys allocated in this subsection, $5,000,000 22 shall be used to expand the capacity of intermittent 23 community-based services that allow an individual to remain 24 in the community and that provide support to the individual, 25 including employment services, hourly supported community 26 living services, respite services, and day habilitation 27 services. 28 2. Iowans support reducing the number of abortions 29 performed in our state. Moneys appropriated under this section 30 shall not be used for abortions, unless otherwise authorized 31 under this section. 32 3. The provisions of this section relating to abortions 33 shall also apply to the Iowa health and wellness plan created 34 pursuant to chapter 249N. 35 -9- LSB 1004SV (1) 91 lh/ko 9/ 32

S.F. 649 4. Of the moneys appropriated in this section, $4,479,762 is 1 allocated for the state supplementary assistance program. 2 5. Of the moneys appropriated in this section, $60,521,998 3 is allocated for maintenance of the Hawki program pursuant 4 to chapter 514I, including supplemental dental services, for 5 receipt of federal financial participation under Tit. XXI of 6 the federal Social Security Act, which creates the children’s 7 health insurance program. 8 HEALTH PROGRAM OPERATIONS 9 Sec. 9. HEALTH PROGRAM OPERATIONS. There is appropriated 10 from the general fund of the state to the department of health 11 and human services for the fiscal year beginning July 1, 12 2025, and ending June 30, 2026, the following amount, or so 13 much thereof as is necessary, to be used for the purposes 14 designated: 15 For health program operations, and the autism support 16 program under section 225D.2: 17 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 39,672,433 18 1. The department of inspections, appeals, and licensing 19 shall provide all state matching moneys for survey and 20 certification activities performed by the department of 21 inspections, appeals, and licensing. The department of health 22 and human services shall be solely responsible for distributing 23 the federal matching moneys for such activities. 24 2. Of the moneys appropriated in this section, a sufficient 25 amount shall be used for the administration of the health 26 insurance premium payment program, including salaries, support, 27 maintenance, and miscellaneous purposes. 28 3. Of the moneys appropriated in this section, $750,000 29 shall be used for a nonprofit organization that provides access 30 to emergency poison information and treatment. Pursuant to 31 the directive under 2014 Iowa Acts, chapter 1140, section 32 102, the federal matching moneys available to the nonprofit 33 organization from the department under the federal Children’s 34 Health Insurance Program Reauthorization Act of 2009 shall be 35 -10- LSB 1004SV (1) 91 lh/ko 10/ 32

S.F. 649 subject to the federal administrative cap rule of 10 percent 1 applicable to moneys provided under Tit. XXI of the federal 2 Social Security Act and shall be included in the department’s 3 calculations of the cap. 4 4. Unless otherwise provided by law, if a contract for 5 services provided under this section initially entered into 6 during the fiscal year beginning July 1, 2025, and ending 7 June 30, 2026, provides for an annual increase of the cost of 8 services provided under the contract, the annual increase shall 9 not exceed the amount by which the consumer price index for 10 all urban consumers increased during the immediately preceding 11 calendar year. This subsection shall not affect a contract 12 entered into on or before June 30, 2025, that is for a term of 13 more than one year. 14 HEALTH CARE ACCOUNTS AND FUNDS 15 Sec. 10. PHARMACEUTICAL SETTLEMENT ACCOUNT —— DEPARTMENT 16 OF HEALTH AND HUMAN SERVICES. There is appropriated from the 17 pharmaceutical settlement account created in section 249A.33 to 18 the department of health and human services for the fiscal year 19 beginning July 1, 2025, and ending June 30, 2026, the following 20 amount, or so much thereof as is necessary, to be used for the 21 purposes designated: 22 Notwithstanding any provision of law to the contrary, to 23 supplement the appropriation made in this Act from the general 24 fund of the state for health program operations under the 25 medical assistance program for the same fiscal year: 26 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 234,193 27 Sec. 11. QUALITY ASSURANCE TRUST FUND —— DEPARTMENT OF 28 HEALTH AND HUMAN SERVICES. Notwithstanding any provision of 29 law to the contrary and subject to the availability of moneys, 30 there is appropriated from the quality assurance trust fund 31 created in section 249L.4 to the department of health and human 32 services for the fiscal year beginning July 1, 2025, and ending 33 June 30, 2026, the following amount, or so much thereof as is 34 necessary, for the purposes designated: 35 -11- LSB 1004SV (1) 91 lh/ko 11/ 32

S.F. 649 To supplement the appropriation made in this Act from the 1 general fund of the state to the department of health and human 2 services for medical assistance for the same fiscal year: 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $111,216,205 4 Sec. 12. HOSPITAL HEALTH CARE ACCESS TRUST FUND —— 5 DEPARTMENT OF HEALTH AND HUMAN SERVICES. Notwithstanding 6 any provision of law to the contrary and subject to the 7 availability of moneys, there is appropriated from the hospital 8 health care access trust fund created in section 249M.4 to the 9 department of health and human services for the fiscal year 10 beginning July 1, 2025, and ending June 30, 2026, the following 11 amount, or so much thereof as is necessary, for the purposes 12 designated: 13 To supplement the appropriation made in this Act from the 14 general fund of the state to the department of health and human 15 services for medical assistance for the same fiscal year: 16 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 33,920,554 17 SEX REASSIGNMENT SURGERY OR TREATMENT 18 Sec. 13. MEDICAL ASSISTANCE PROGRAM —— SEX REASSIGNMENT 19 SURGERY OR TREATMENT. Moneys appropriated in this Act from 20 the general fund of the state to the department of health and 21 human services for the fiscal year beginning July 1, 2025, and 22 ending June 30, 2026, and allocated for the medical assistance 23 program, shall not be used for sex reassignment surgery 24 or treatment related to an individual’s gender dysphoria 25 diagnosis. The department of health and human services shall 26 adopt rules pursuant to chapter 17A to administer this section. 27 Sec. 14. REIMBURSEMENT RATES. 28 1. Reimbursement for medical assistance, state 29 supplementary assistance, and social service providers and 30 services reimbursed under the purview of the department 31 of health and human services shall remain at the current 32 reimbursement rate, or shall be determined pursuant to the 33 reimbursement methodology in effect on June 30, 2025, with the 34 following exceptions: 35 -12- LSB 1004SV (1) 91 lh/ko 12/ 32

S.F. 649 a. If reimbursement is otherwise negotiated by contract or 1 pursuant to an updated fee schedule. 2 b. As otherwise provided in this division. 3 2. Of the moneys appropriated for medical assistance 4 program reimbursement and associated costs as specifically 5 provided in the reimbursement methodologies in effect June 6 30, 2025, the following amounts, or so much thereof as is 7 necessary, are allocated to the department of health and human 8 services to be used for the following purposes: 9 a. (1) Notwithstanding any provision of law to the 10 contrary, for the fiscal year beginning July 1, 2025, and 11 ending June 30, 2026, the department of health and human 12 services shall rebase case-mix nursing facility rates beginning 13 July 1, 2025, using the Medicaid cost reports on file for 14 the period ending December 31, 2024, to the extent possible 15 within state funding, including no more than $16,000,000 16 from the allocation provided for medical assistance program 17 reimbursement and associated costs. 18 (2) The department of health and human services shall 19 calculate each nursing facility’s case-mix index for the period 20 beginning July 1, 2024, using weighting based on the current 21 patient-driven payment model schedule. Rosters shall be 22 made to show a separate calculation to determine the average 23 case-mix index for a nursing-facility-wide case-mix index, and 24 a case-mix index for the residents of a nursing facility who 25 are Medicaid recipients using all minimum data set reports by 26 the nursing facility for the previous semiannual period using a 27 day weighted calculation. 28 b. For the fiscal year beginning July 1, 2025, $420,000 29 shall be used to increase to the extent possible reimbursement 30 rates for maternal health providers compared to the rates in 31 effect on June 30, 2025. 32 c. For the fiscal year beginning July 1, 2025, $2,000 shall 33 be used to increase to the extent possible reimbursement rates 34 for certified nurse midwives compared to the rates in effect 35 -13- LSB 1004SV (1) 91 lh/ko 13/ 32

S.F. 649 on June 30, 2025. 1 d. For the fiscal year beginning July 1, 2025, reimbursement 2 rates for home health agencies shall continue to be based 3 on the Medicare low utilization payment adjustment (LUPA) 4 methodology with state geographic wage adjustments and shall be 5 adjusted to increase the rates to the extent possible. 6 e. For the fiscal year beginning July 1, 2026, and for 7 each fiscal year thereafter, the department shall review the 8 reimbursement rates for home health agencies and pharmacy 9 dispensing fees. 10 NURSING FACILITIES —— REIMBURSEMENT METHODOLOGY PROPOSAL 11 Sec. 15. NURSING FACILITIES —— MEDICAID REIMBURSEMENT 12 METHODOLOGY PROPOSAL. 13 1. By April 1, 2026, the department of health and human 14 services shall develop a reimbursement methodology proposal for 15 reimbursement of nursing facilities under the Medicaid program 16 that includes all of the following: 17 a. A base-rate payment component. 18 b. A quality assurance assessment pass-through component. 19 c. A quality assurance add-on component, which includes a 20 fixed fee payment and a quality-based payment. 21 2. The reimbursement methodology proposal shall include 22 recommendations developed by the department of health and human 23 services, in consultation with stakeholders including the Iowa 24 health care association and leadingage Iowa, for specific 25 metrics the department of health and human services will use 26 to determine whether a nursing facility is eligible to receive 27 all or a portion of the quality-based payment portion of the 28 reimbursement to the nursing facility. 29 3. The total state expenditures for reimbursement of 30 nursing facilities under the Medicaid program using the 31 reimbursement methodology proposed in this section shall 32 not exceed the amount appropriated for this purpose for the 33 applicable fiscal year. 34 NURSING FACILITY FORECASTING FORMULA 35 -14- LSB 1004SV (1) 91 lh/ko 14/ 32

S.F. 649 Sec. 16. NURSING FACILITY BED FORECASTING FORMULA —— WORK 1 GROUP. 2 1. The department of health and human services shall 3 establish a work group to make recommendations for a 4 forecasting formula to ensure a sufficient number of nursing 5 facility beds are available to meet the future demand for 6 nursing facility beds. 7 2. The work group shall include all of the following 8 members: 9 a. The director of health and human services, or the 10 director’s designee. 11 b. The director of the department of inspections, appeals, 12 and licensing, or the director’s designee. 13 c. Multiple representatives of nursing facilities located 14 in this state. 15 d. A representative from each managed care organization 16 acting pursuant to a contract with the department of health and 17 human services to administer the medical assistance program 18 under chapter 249A. 19 e. A representative of appropriate stakeholders as 20 determined by the director of health and human services. 21 3. On or before July 1, 2026, the department of health and 22 human services shall use the recommendations from the work 23 group to develop and implement a forecasting formula to ensure 24 a sufficient number of nursing facility beds are available to 25 meet the future demand for nursing facility beds. 26 4. The department of health and human services shall 27 consider the forecasting formula developed and implemented 28 under subsection 3 to complete the formal review of an 29 application for a certificate of need under section 10A.719. 30 DIVISION VII 31 FAMILY WELL-BEING AND PROTECTION —— FY 2025-2026 32 STATE CHILD CARE ASSISTANCE 33 Sec. 17. STATE CHILD CARE ASSISTANCE. There is appropriated 34 from the general fund of the state to the department of health 35 -15- LSB 1004SV (1) 91 lh/ko 15/ 32

S.F. 649 and human services for the fiscal year beginning July 1, 1 2025, and ending June 30, 2026, the following amount, or so 2 much thereof as is necessary, to be used for the purposes 3 designated: 4 For state child care assistance in accordance with sections 5 237A.13 and 237A.14: 6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 34,983,000 7 1. If the appropriation made for purposes of the state child 8 care assistance program for the fiscal year are determined to 9 be insufficient, it is the intent of the general assembly to 10 appropriate sufficient moneys for the fiscal year to avoid 11 application of waiting list requirements. 12 2. A portion of the state match for the federal child care 13 and development block grant shall be provided as necessary to 14 meet federal matching moneys requirements through the state 15 general fund appropriation made for child development grants 16 and other programs for at-risk children in section 279.51. 17 EARLY INTERVENTION AND SUPPORTS 18 Sec. 18. EARLY INTERVENTION AND SUPPORTS. There is 19 appropriated from the general fund of the state to the 20 department of health and human services for the fiscal year 21 beginning July 1, 2025, and ending June 30, 2026, the following 22 amount, or so much thereof as is necessary, to be used for the 23 purposes designated: 24 For promoting optimum health status for children and 25 adolescents from birth through 21 years of age, and for 26 families: 27 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 36,301,904 28 1. Of the moneys appropriated in this section, not more 29 than $734,000 shall be used for the healthy opportunities for 30 parents to experience success (HOPES)-healthy families Iowa 31 (HFI) program established pursuant to section 135.106. 32 2. Of the moneys appropriated in this section, $4,313,854 33 is allocated for the FaDSS grant program, and not more than 5 34 percent of the moneys shall be used for administration of the 35 -16- LSB 1004SV (1) 91 lh/ko 16/ 32

S.F. 649 grant program. 1 3. Of the moneys appropriated in this section, $29,256,799 2 shall be deposited in the early childhood Iowa fund created in 3 section 256I.11. 4 4. Of the moneys appropriated in this section, $1,000,000 5 shall be used for the purposes of program administration and 6 provision of pregnancy support services through the more 7 options for maternal support program in accordance with section 8 217.41C. 9 CHILD PROTECTIVE SERVICES 10 Sec. 19. CHILD PROTECTIVE SERVICES. There is appropriated 11 from the general fund of the state to the department of health 12 and human services for the fiscal year beginning July 1, 13 2025, and ending June 30, 2026, the following amount, or so 14 much thereof as is necessary, to be used for the purposes 15 designated: 16 For child, family, and adoption services, and for salaries, 17 support, maintenance, and miscellaneous purposes: 18 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $166,308,818 19 1. Of the moneys appropriated in this section, $1,717,000 20 is allocated specifically for expenditure for the fiscal 21 year beginning July 1, 2025, through the decategorization 22 services funding pools and decategorization governance boards 23 established pursuant to section 232.188. 24 2. A portion of the moneys appropriated in this section 25 may be used to provide other resources based on client need 26 required to support family preservation, emergency client need, 27 or family reunification efforts. 28 3. Of the moneys appropriated in this section, a sufficient 29 amount is allocated for foster family care, group foster care 30 maintenance and services, shelter care, child welfare emergency 31 services, qualified residential treatment programs, supervised 32 apartment living contracts, and for medical assistance program 33 reimbursement and associated costs. 34 4. Federal moneys received by the state during the fiscal 35 -17- LSB 1004SV (1) 91 lh/ko 17/ 32